Economic Burden of Tuberculosis Care

The economic burden of tuberculosis care encompasses the full range of expenses incurred by individuals and households affected by TB, extending from direct medical payments to indirect losses of income and productivity. Despite the provision of free or subsidised treatment in many settings, patients frequently face out-of-pocket expenditures for diagnostics, transport, supplementary nutrition and accommodation. Indirect costs such as lost earnings during prolonged treatment and caregiving duties can exceed direct payments, driving households into poverty and undermining adherence. Catastrophic costs—defined by the proportion of household income devoted to TB care—remain alarmingly high in diverse regions. This economic strain not only exacerbates social inequities but also impedes progress towards global TB control targets. Addressing this burden requires integrated social protection measures, innovative financing models and multisectoral collaboration to safeguard livelihoods and sustain treatment outcomes.

Research from Nature Portfolio

Recent systematic analyses have synthesised data from multiple settings to quantify the prevalence and predictors of catastrophic costs among TB-affected households. A comprehensive review of nearly thirty studies reported that around 43% of TB patients incur catastrophic expenditures, with higher proportions observed among those with drug-resistant disease or HIV co-infection. Meta-regression identified country context, case-finding approach and disease resistance profile as primary determinants. The findings underscore the necessity of embedding socioeconomic support alongside biomedical interventions, highlighting that even passive case detection and ostensibly free care may leave families vulnerable to financial ruin.

Economic Burden of Tuberculosis Care publication trend

The graph below shows the total number of articles in economic burden of tuberculosis care across all publications each year (not limited to Nature Index journals).

Technical terms

Catastrophic costs: TB-related household expenditure exceeding 20% of annual pre-TB income, often resulting in severe financial hardship.

Direct costs: Out-of-pocket payments for consultations, diagnostics, drugs, transport and ancillary services associated with TB care.

Indirect costs: Losses of income and productivity borne by patients and caregivers due to illness, hospitalisation and treatment schedules.

References

1. A systematic review and meta-analysis of the catastrophic costs incurred by tuberculosis patients. Scientific Reports (2022).
2. Is convenience really king? Comparative evaluation of catastrophic costs due to tuberculosis in the public and private healthcare sectors of Viet Nam: a longitudinal patient cost study. Infectious Diseases of Poverty (2024).
3. Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India. Global Health Research and Policy (2024).
4. Defining Catastrophic Costs and Comparing Their Importance for Adverse Tuberculosis Outcome with Multi-Drug Resistance: A Prospective Cohort Study, Peru. PLOS Medicine (2014).